FELLOWSHIP TRAINING PROGRAM IN NEONATAL‑PERINATAL MEDICINE
Core curriculum, revised 12/04/08
Physiology/Pathology Course Thursday 7:45 AM
Placental Growth & Blood Flow
Placental Transport & Function
Maternal Nutrients and Fetal Growth & Development
Hormonal Regulation of Growth & Development
Alterations in Fetal Growth and Outcome
Clinical Assessment of Maternal-Fetal Blood Flow and Growth
Physiology of Amniotic Fluid Production & Clearance
Cardiac Development & Congenital Heart Disease
Development and Regulation of Fetal Cardiovascular System
Cardiovascular Adjustments at Birth
Postnatal Blood Pressure Regulation
Ductus Arteriosus: Physiology & Pathophysiology
Lung Growth and Development: Alveolar and Vascular
Lung Growth and Development: Surfactant Lipids and Proteins
Hyaline Membrane Disease: Pathophysiology
Pulmonary Hypertension: Pathophysiology
Control of Respiration: Pathophysiology of Apnea
Control of Respiration: Pharmacology of Theophylline/Caffeine
Chronic Lung Disease: Pathophysiology
Postnatal Temperature Regulation
Genetics: Molecular basis of inherited diseases
Genetics: Cytogenetics in pre- and post-natal diagnosis
Genetics: Prenatal diagnosis – screening tests and ultrasound
Genetics: Approach to inborn errors of metabolism
Genetics: Teratology and dysmorphology
Renal development and functional maturation
Fluid and electrolyte balance
Anomalies of the GI tract: Pathogenesis and Diagnosis I
Anomalies of the GI tract: Pathogenesis and Diagnosis II
Gastroesophageal reflux: Pathogenesis and Diagnosis
Fetal and neonatal glucose homeostasis
Nutrition: metabolic needs after birth
Nutrition: use of parenteral nutrients
Nutrition: initiation and use of oral nutrients
Nutrition: vitamin and mineral requirements
Breast Milk and Preterm Feeds
NEC: pathophysiology
NEC: epidemiology and diagnosis
Bilirubin metabolism
Pathogenesis of hyperbilirubinemia
Hemolytic Diseases of Newborn
Anemia of Prematurity & Transfusion Therapy
Physiology of Cerebral Blood Flow
Neonatal Intracranial Hemorrhage: Epidemiology/Pathogenesis
Neonatal Coagulation & Coagulopathy
Neonatal Early Onset Infection
Neonatal Nosocomial Infection
Diagnosis of Neonatal Infection
Perinatal Infection: HIV and Syphilis
Perinatal Infection: CMV, Herpes & Toxoplasmosis
Fetal/Neonatal Adrenal Development and Function
Fetal/Neonatal Thyroid Development and Function
Retinopathy of Prematurity: Retinal Development and Pathogenesis
Retinopathy of Prematurity: Epidemiology
VLBW Outcome: Neurologic Development
VLBW Outcome: Growth
Fetal Hydrops: Pathogenesis & Diagnosis
Neonatal Pharmacology I
Neonatal Pharmacology II
Pharmacokinetic calculations
Evidence-based Medicine Conference Thursday 7:45 AM
Reference textbooks (provided to fellows)
Designing Clinical Research. SB Hulley, SR Cummings, WS Browner, DG Grady, TB Newman. Williams and Wilkins, 2007.
Evidence-Based Medicine. S Strauss, WS Richardson, P Glasziou, RB Haynes, Churchill Livingstone, 2005.
Strauss Evidence-based Medicine Intro, chap 1-2
Strauss Evidence-based medicine, chap 5
Getting Started Hulley & Cummings Chap 1-2; Sackett 1-29
Choosing Study Subjects and Planning Measurements Hulley & Cummings Chap 3-4
Therapeutic studies Hulley & Cummings Chap. 5 sample size
Therapeutic studies Hulley & Cummings Chap 6 - Sample Size & Power
Sackett Therapy Chap 5 - Reich Article
Clinical Trials I Hulley & Cummings
Clinical Trials II Chap 10 - Hulley & Cummings Chap 11
Ethical Issues Hulley & Cummings Chap 14 -
Designing Questionnaires and Data Collection Instruments Hulley & Cummings Chap 15 -
Data Management Hulley & Cummings Chap 16 -
Diagnostic Tests- Sackett p 67-93 Hulley & Cummings Chap. 1-2
Diagnostic Test-Hulley Chap. 12
Therapeutic studies-Sackett p 105-133; Sacket Chap 1 p13-27
Current best evidence Sacket Chap 2
Meta-analysis Sacket p 133-138
Harm and Guidelines- Sackett p 155-182
Prognostic Studies-Sackett p 95-103
Diagnostic and Screening Tests: positive predictive value (PPV), negative predictive value
(NPV), sensitivity, specificity, receiver operating characteristic (ROC) curve
Variables and Distribution
Prognosis, positive likelihood ration, negative likelihood ratio
Physiology/Prognosis Article for Journal Club
Survival Analysis
Physiology/Survival Analysis Article for Journal Club
Therapy; parametric Statistics, Straus Chap 5
Physiology/Therapeutic Article Using Parametric Statistics for Journal Club
Designing a Randomized Blinded Trial; Non-Parametric Statistics: H&C Chapter 10
Physiology/Therapeutic Article Using Non-parametric Statistics for Journal Club
Power, Number Needed to Treat, Sample Size: H&C Chapter 6
Physiology/Therapeutic Article focusing on power, NNT and Sample Size
Logistic Regression
Physiology/Therapeutic Article that uses Logistic Regression
Harm: Straus Chap 6
Physiology/Therapeutic Article focused on Prevention of Harm
Resuscitation conference Monday 12 PM
Indications for high-risk delivery that should prompt calling the Resuscitation Team and in addition when the Resuscitation team should call for additional support (Fellow, NNP, Faculty)
Non-Reassuring Fetal Heart Rate Tracings
Physiology of primary and secondary apnea in response to hypoxia
The importance of gathering maternal and fetal information prior to delivery
The importance of setting-up and checking all equipment that one might need for an effective resuscitation
Oxygen use for preterm infants in the delivery room
Oxygen versus RA for Resuscitation
The routine use of oxygen in the DR for vigorous infants
Initial Steps of Resuscitation
Temperature Regulation in the Delivery Room-Term and Preterm
The paramount importance of providing effective ventilation (how do you achieve it, how to you judge the effectiveness)
Self-inflating bags, anesthesia bags, T-Piece Resuscitators
Meconium physiology
Management of the meconium exposed infant
The difficult airway that cannot be intubated
EXIT Procedure-indications and management
Use of LMA
Stabilization of the pre-term newborn
Stabilization of the hydropic newborn
Stabilization of the hypovolemic newborn
Stabilization of the newborn with diaphragmatic hernia
Stabilization of the newborn with cyanotic congenital heart disease
Stabilization of the newborn with abdominal wall defects
Stabilization of the Rh disease infant
Stabilization of the infant with spinal defect
Stabilization of the infant with Pierre-Robin
Differential Diagnosis of the severely depressed infant
Importance of leadership and good communication during resuscitation
Coordination of cardiac compressions during neonatal CPR
Physiology of cardiac compressions during neonatal CPR
Placement of emergent IV access in the DR
Evidence for use of epinephrine during neonatal CPR
Evidence for use of volume administration during neonatal CPR
Evidence for use of sodium bicarbonate during neonatal CPR
Evidence for use of Naloxone during neonatal resuscitation
Consideration and management of pneumothorax in the delivery room
Indications for and issues regarding intubation in the DR
When is it appropriate to redirect care in the delivery room
When is it appropriate to not initiate resuscitation
How to communicate with families in the delivery room
Benefits and risks of End-tidal CO2 detectors to confirm airway placement in the DR
Resuscitation of the newborn outside the delivery room (NICU)
Resuscitation of the newborn outside the delivery room (ambulance dock, ER etc)
Use and abuse of the Apgar score
How to utilize QA in the DR to improve performance
Effects of maternal anesthesia on newborn stabilization
OB/GYN Ultrasound, Prenatal Diagnosis & Genetics Grand Rounds, Friday 12 PM
Anomaly Reviews and Updates
Thorax
The Endometrium and Sonohysterography
Fetal Cardiac Evaluation
Genetic Counseling Strategies for Health Care Providers
Fetal GI
Trisomy 13 and 18
Fetal GU
Fetal Skeletal Dysplasias
Applications of Molecular Cytogenetics
Placenta and Cervix
Imaging Maternal Complications
Twins
First and Second Trimester Down Syndrome Screening
Fetal CNS
Cystic Fibrosis & Other Genetic Carrier Testing
Innovations in Fetal Therapy
Mortality/morbidity (Parkland and CMC) and Clinical Care Conference
Tuesday 12 PM (CMC) and Thursday 12 PM (PHHS)
Imaging
Radiology: chest
Radiology: abdomen
Ultrasononography: abdomen
Neurosononography: I and II
Neuro CT/MRI
Respiratory
Surfactant therapy
Artificial ventilation: conventional
HFO
High frequency Jet ventilation
BPD
Pulmonary hemorrhage
Meconium Aspiration
Apnea of prematurity
Apnea of infancy
PFT’s
Respiratory surgical problems in the newborn
CCAM/Pulmonary sequestration
Congenital diaphragmatic hernia
PPHN, nitric oxide
PIE
Pneumothorax
Cardiovascular system:
ECMO: PICU
EKG, arrhythmia
Pacing
Transitional/Post natal circulation
Cyanosis
2D echo
CHF
Congenital heart disease: differential diagnosis
Cardiac surgery in neonates
Hypotension, Shock
Single ventricle
TAPVR
Coarctation
HLH
Conotruncal anomalies
Heterotaxy
Cardiomyopathy
Myocarditis
Vein of Galen
AVM
Cardiac tumor
Growth and nutrition:
Small for gestational age/IUGR
Macrosomia
IDM, Gestational diabetes
Abnormalities in fetal growth, SGA, LGA, perinatal
Endocrinology/Metabolism
Hypoglycemia
Hyperglycemia
Metabolic diseases (2 or 3 talks)
Neonatal screening
Galactosemia
Endocrinology:
Calcium and phosphate
Osteopenia
Hypoglycemia
Thyroid treatment
Ambiguous genitalia
Steroids treatment
Genetics:
Prenatal genetic diagnosis
Approach to congenital malformations
Down syndrome
Trisomy 13
Trisomy 18
Other chromosomal anomalies
Craniofacial malformations: treatment
Craniosynostosis
GI Tract:
NEC
Gastroschisis & omphalocele
TEF
Duodenal Atresia & stenosis
Jejunal/ileal stenosis & atresia
Malrotation
Meconium plug & ileus
Short bowel syndrome
Bile secretion, metabolism
Liver disease & cholestasis
Meconium plug & ileus
Intestinal obstructions
Hirschsprung’s disease
Imperforate anus
Cloacal abnormalities
Hematology/Oncology:
Hyperbilirubinemia
Anemia, hematopoiesis
Polycythemia
Neutropenia
Thrombocytopenia
Thrombophilia
Hemostasis
Blood transfusion
Blood typing and antibodies screening
Erythropoeitin in the newborn
Leukemoid reaction
Teratoma
Neuroblastoma
Angioma
Vascular tumor
Retinoblastoma
Myofibromatosis
Iron
Renal, fluids:
Acute renal failure
Congenital renal anomalies with renal failure
Hypertension
Fluid management: Approach to hyponatremia, hypernatremia, hyperkalemia and acidosis
GU Anomalies: medical therapy
Surgery for GU anomalies
Hydrops
Infectious diseases
HIV
GBS
Syphilis
TORCH
TB
Hepatitis
Parvovirus
Herpes
Yeast
RSV
Listeria
Gram negative sepsis
Immunology:
Immune deficiency diseases
HLH
Neonatal Lupus
Other systemic diseases
Tuberous sclerosis
Neurofibromatosis
Cystic fibrosis
Neurology:
EEG
Congenital muscle disorders
Neural tube defects and folic acid
Congenital CNS malformations
Holoprosencephaly and agenesis of the corpus callosum
Dandy Walker malformation
Head trauma
Brachial plexus injury
Pain management
Hydrocephalus and management
Seizures
Stroke
Microcephaly
Congenital Myasthenia Gravis
Other Neuromuscular disorders
Hypoxic Ischemic Encephalopathy
Pain, sedation
Neonatal anesthesia
Withdrawal/ Toxicology
Pain management
Eye, ENT, dermatology
ROP
Vitamin E supplementation
Skin maturation
Vesicles and bullae
Hearing screening, hearing loss
Stridor in neonates
Glaucoma
Cataract
Orthopedics
Hip dysplasia
OTHER:
Teaching and Assessing Professionalism: ABP and APPD 2008
Conflict resolution
Cultural diversity, disparities
Medicolegal aspects of neonatology
Computers in medicine
Perinatal/neonatal Ethics
Practice management
Neonatology practice venue
Finances: Medicaid/medicare/insurance/Billing
Breaking bad news: Prenatal
Breaking bad news: Redirecting care
Breaking bad news: DNR
Transport, altitude physiology
Asphyxia
Life after Fellowship Wednesday 12 PM
First steps, assessing a practice venue
Interview, negotiation
Billing: various models
Types of private practice:
- Small group practice
- Large national practice
Private non-profit hospital-based practice
Academic:
Clinical track
Clinical scholar track
Research track
Orientation of First Year Fellows
UTSW Orientation: Human Resources 6363 Forest Park Rd, 14th floor.
Children’s Medical Center General Orientation: CMC, Doctor’s Dining Room
Parkland’s All Day General Orientation: Parkland, Gooch Auditorium
Neonatal-Perinatal Medicine Fellowship orientation,
Pediatrics Conference Room F3.112
Division of Neonatology Welcome Breakfast
Goals and Objectives of the program
Department of Pediatrics and UTSW
Clinical training
Education in neonatology, pediatrics and UTSW
Scholarship
Evaluation and feedback
A.W. Faculty Club – Lunch
Parkland 5 South E Conference –Orientation to Parkland resuscitation and NNICU
Transport Ventilator: Bronchotron: F3.112
Transport Services, Love Field Airport, 8111 Lemmon Ave., Ste 200, Dallas, TX 75209
Transport operations and expectations
Rotor Wing training
Lunch
Flight Safety
Fixed Wing Safety Training
Orientation to NICHD Neonatal Network
Parkland NNICU- Parkland 5 South E Conf Rm:
Conventional ventilation
High-frequency ventilation,
CPAP, oxygenation
Fellows NICU Procedure Skills Lab
CMC NICU Respiratory Therapy Orientation:
Siemens ventilator,
High-frequency jet ventilation,
End tidal CO2,
High frequency oscillation
CMC NICU orientation
Computer programs for CMC rotations: ICU DOC, Tecsys, iSite, Apollo
Department of Pediatrics: Fellows Core Conference Thursday 5 PM
1. Physician Care – Fatigue, Impairment, CME
2. Prevention of Medical Errors – QA, Recertification
3. Program Administration
4. Economic and Development of Health Care
5. Proficiency in Teaching – Bedside, Large Groups
6. Principles of Evidenced-Based Medicine
7. Critical Literature Review
8. Bioethics – Patient care, Research
9. Preparation of Funding Applications
10. Preparation of Research protocols
11. Study Design
12. Research Methodology: Clinical, Laboratory
13. Biostatistics
14. Career Development – Choices
Specific Topics 07-09
Fatigue and On-Call Schedule
Why is a Research Experience Required?
Choosing a Clinical or Basic Research Mentor
Intrusive Regulations and the Medical Profession
Protection of Research Subjects: Learning the Alphabet
How to Write an Informed Consent
Masters Program in Clinical Investigation
Faculty Presentation of Clinical Research
Ethics of Animal Research
IACUC Requirements for Animal Research
Faculty Presentation of Laboratory Research
Physician Impairment
Why Continuing Medical Education And Recertification?
Choosing a Career Path
Principles of Evidenced-Based Medicine
How to use Evidenced-Based Medicine
Career Development: Small Group Discussion x 3
Faculty Research Presentations
Principles of Bedside Teaching
Quality Assurance & Prevention of Medical Errors
Choice of Performance Indicators in the Practice of Medicine
Evidence-based Medicine
Practicing Evidence-based Medicine
Research presentations
Small group sessions
